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BACKGROUND: Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with an increasing incidence and unknown aetiology. AIM: To identify possible environmental and hormonal factors related to FFA. METHODS: We conducted a multicentre case-control study paired by sex and age, and recruited 664 women (335 cases and 329 controls) and 106 men (20 cases and 86 controls). Study subjects completed an exhaustive questionnaire enquiring about pharmacological, environmental, hormonal, social, job exposure, lifestyle, drugs and diet factors to which they were exposed at least 5 years prior to the onset of the disease. RESULTS: For women, there was a statistical association between alopecia and history of pregnancy (OR = 1.6; 95% CI 1.06-2.41), use of facial sunscreen (OR = 1.6; 95% CI 1.06-2.41) and hormone replacement therapy (HRT) (OR = 1.76; 95% CI 1.11-2.8) or raloxifene (no controls exposed therefore OR was not calculated), exposure to alkylphenolic compounds (OR = 1.48; 95% CI 1.05-2.08), and presence of rosacea (OR = 1.91; 95% CI 1.07-3.39), lichen planus pigmentosus (LPP) (OR = 5.14; 95% CI 1.11-23.6) or hypothyroidism (OR = 1.73; 95% CI 1.11-2.69). For men, there was a statistical association between alopecia and use of facial sunscreens (OR = 11.6; 95% CI 1.7-80.9) or antiageing creams (OR = 1.84; 95% CI 1.04-3.23). CONCLUSIONS: FFA seems to be associated with hormonal exposure (pregnancy, HRT and raloxifene), comorbidities (hypothyroidism, LPP and rosacea) and environmental factors (facial sunscreens, antiageing creams and occupational exposure). Further research is required to analyse the exact mechanism in which these environmental factors participate in the development of this alopecia.

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Se presenta el caso clínico de un varón de 80 años diagnosticado de leiomiosarcoma testicular primario, a raíz de alteraciones del perfil hepático en analítica sanguínea y lesiones ocupantes de espacio (LOE) hepatoesplénicas en ecografía abdominal. En primer lugar, se realizó punción de lesión hepática y posteriormente orquiectomía radical, revelando concordancia histológica, compatible con leiomiosarcoma intratesticular. Presentamos el caso clínico debido a la rareza de ese tipo de tumores, sobre todo en estadio III, y su peculiar diagnóstico, tras la detección de alteración hepática tanto analítica como ecográfica

We present a case of an 80-year-old male diagnosed with primary testicular leiomyosarcoma due to the detection of hepatic profile analytical alterations and hepatosplenic space-occupying lesions in abdominal ultrasound. Puncture of hepatic lesion was performed first and radical orchiectomy later, revealing histological concordance, compatible with intratesticular leiomyosarcoma. We present the case due to the uncommon of this type of tumors, especially in stage III and its peculiar diagnosis, secondary of hepatic alteration, both analytic and ultrasound.

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La sarcoidosis es una enfermedad crónica multisistémica de etiología desconocida. La histiocitosis eruptiva generalizada (HEG) es una forma rara de histiocitosis no Langerhans, de curso benigno y autorresolutivo. Presentamos el caso de una niña de 8 años de edad con sarcoidosis que fue inicialmente diagnosticada en forma errónea de HEG. Fue tratada con corticoides orales, metotrexato y adalimumab, con los que se logró un control insuficiente de la uveítis. La introducción de infliximab permitió un control del compromiso oftalmológico y reducir la dosis de corticoides. En algunos casos de sarcoidosis la falta de granulomas bien organizados en el inicio de la enfermedad, así como la presencia de células gigantes, puede sugerir diagnósticos alternativos como la histiocitosis no Langerhans. Aunque la experiencia del uso de antagonistas del factor de necrosis tumoral alfa en niños con sarcoidosis es limitada, puede ser útil en aquellos pacientes con enfermedad severa y refractaria(AU)

Sarcoidosis is a chronic multisystemic granulomatous disease of unknown origin. Generalised eruptive histiocytosis is a rare, benign, self-healing, non-Langerhans’ cell histiocytosis (non-LCH).We report the case of an 8-year-old girl with sarcoidosis who was misdiagnosed as non-LCH. She was treated with oral corticosteroids, methotrexate and adalimumab, but there was insufficient control of ocular disease. The introduction of infliximab achieved a control of the uveitis and enabled the corticosteroid dose to be tapered. In some cases of sarcoidosis the lack of well-organised granuloma formation at the beginning of the disease, and the presence of prominent giant cells may suggest alternative diagnoses, such as non-LCH. Although the experience of tumour necrosis factor-alpha antagonists use in children with sarcoidosis is limited, these drugs may be helpful for those patients experiencing a severe and refractory disease(AU)

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Sarcoidosis is a chronic multisystemic granulomatous disease of unknown origin. Generalised eruptive histiocytosis is a rare, benign, self-healing, non-Langerhans' cell histiocytosis (non-LCH). We report the case of an 8-year-old girl with sarcoidosis who was misdiagnosed as non-LCH. She was treated with oral corticosteroids, methotrexate and adalimumab, but there was insufficient control of ocular disease. The introduction of infliximab achieved a control of the uveitis and enabled the corticosteroid dose to be tapered. In some cases of sarcoidosis the lack of well-organised granuloma formation at the beginning of the disease, and the presence of prominent giant cells may suggest alternative diagnoses, such as non-LCH. Although the experience of tumour necrosis factor-α antagonists use in children with sarcoidosis is limited, these drugs may be helpful for those patients experiencing a severe and refractory disease.

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